Go Soken, Yamanaka Gaku, Kasuga Akiko, Kanou Kanako, Takamatsu Tomoko, Takeshita Mika, Morishita Natsumi, Morichi Shinichiro, Ishida Yu, Oana Shingo, Kashiwagi Yasuyo, Mitsufuji Takashi, Araki Nobuo, Kawashima Hisashi
Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo 160-0023, Japan.
Department of Psychosomatic Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo 183-8561, Japan.
J Clin Med. 2020 Dec 21;9(12):4125. doi: 10.3390/jcm9124125.
Although head and/or neck pain attributed to orthostatic hypotension is included in international guidelines, its mechanisms and relevance remain unknown. This study examined the term's relevance and aimed to elucidate the associated clinical features.
An active stand test was performed to evaluate fluctuations in systemic and cerebral circulation in children and adolescents reporting complaints in the absence of a confirmed organic disorder. The subjects were categorized based on orthostatic headache presence/absence, and their characteristics and test results were compared.
Postural tachycardia syndrome was observed in 50.0% of children with, and 55.1% without, orthostatic headache. For orthostatic hypotension, the respective values were 31.3% and 30.6%. A history of migraine was more prevalent in children with orthostatic headaches (64.1% vs. 28.6%; < 0.01). The observed decrease in the cerebral oxygenated hemoglobin level was larger in children with orthostatic headaches (Left: 6.3 (3.2-9.4) vs. 4.1 (0.8-6.1); < 0.01, Right: 5.3 (3.1-8.6) vs. 4.0 (0.8-5.9); < 0.01).
Fluctuations in cerebral blood flow were associated with orthostatic headaches in children, suggesting that the headaches are due to impaired intracranial homeostasis. As orthostatic headache can have multiple causes, the term "head and/or neck pain attributed to orthostatic (postural) hypotension" should be replaced with a more inclusive term.
尽管国际指南中纳入了归因于直立性低血压的头颈部疼痛，但其中机制及相关性仍不明。本研究探讨了该术语的相关性，并旨在阐明相关临床特征。
对报告有症状但未确诊器质性疾病的儿童及青少年进行主动站立试验，以评估全身及脑循环波动情况。根据是否存在直立性头痛对受试者进行分类，并比较其特征及试验结果。
有直立性头痛的儿童中50.0%观察到姿势性心动过速综合征，无直立性头痛的儿童中这一比例为55.1%。对于直立性低血压，相应比例分别为31.3%和30.6%。直立性头痛儿童中偏头痛病史更为普遍（64.1%对28.6%；P<0.01）。直立性头痛儿童中观察到的脑氧合血红蛋白水平下降幅度更大（左侧：6.3（3.2 - 9.4）对4.1（0.8 - 6.1）；P<0.01，右侧：5.3（3.1 - 8.6）对4.0（0.8 - 5.9）；P<0.01）。
儿童脑血流波动与直立性头痛相关，提示头痛是由于颅内稳态受损所致。由于直立性头痛可能有多种原因，“归因于直立性（姿势性）低血压的头颈部疼痛”这一术语应被更具包容性的术语所取代。
